National Pharmacist Day Spotlight: The Expanding Role of Pharmacists in Serious Mental Illness Care

In recognition of National Pharmacist Day, Michael McGuire, PharmD, highlights how pharmacists are increasingly serving as essential care partners for individuals living with serious mental illness. Drawing on his experience in psychiatric care, McGuire emphasizes that pharmacists are often one of the most consistent points of contact for patients navigating complex, long-term treatment regimens, allowing them to identify early signs of nonadherence, symptom changes, and medication-related concerns. He underscores the pharmacist’s unique position to bridge gaps between mental and physical health care, support psychiatrists amid ongoing workforce shortages, and improve continuity of care within a fragmented system.

Pharmacy Times: Psychiatric care has traditionally centered on psychiatrists and therapists. From your perspective, how has the role of the pharmacist evolved within serious mental illness care?

Michael McGuire, PharmD: Mental health care may involve many different care providers, including psychiatric nurse practitioners, psychiatrists, therapists, and pharmacists. Pharmacists are frequently one of the most consistent points of contact for people living with serious mental illness (SMI). Even if someone misses an occasional appointment with their provider, they still come to the pharmacy for medication fills, giving pharmacists opportunities to notice how they are doing.

I’ve had psychiatrists tell me that some of the most valuable calls they receive are from pharmacists flagging concerns about a patient’s symptoms or adherence. That kind of communication isn’t routine yet, but it’s becoming more common as pharmacists take on roles beyond dispensing medication, such as administering long-acting injectables, helping navigate access issues, and bridging gaps in a very disjointed system.

Pharmacy Times: Medication regimens for patients with serious mental illness are often complex and long-term. How do pharmacists contribute to more comprehensive treatment planning beyond simply dispensing medications?

McGuire: With SMI, the challenge usually isn’t just choosing a medication; rather, it’s making sure the plan actually works once the patient leaves the room. Pharmacists are often the healthcare providers with the closest visibility into all the medications that a patient is receiving, creating an opportunity to observe drug therapy problems that may not otherwise be readily apparent. We also often end up dealing with coverage issues, missed doses, or trying to verify what a patient actually received at another facility. We’re catching potential medication errors and calling other providers when something doesn’t add up. I’ve had situations where a pharmacist was the only reliable source of information about whether a patient received their medication. That kind of involvement goes well beyond dispensing, as it’s about helping the care team make safer decisions and keeping patients stable in a system that may not communicate well.

Pharmacy Times: Patients with serious mental illness frequently have co-occurring physical health conditions. How can pharmacists help bridge the gap between mental health care and physical health management in an integrated care model?

McGuire: Yes, many patients living with SMI are also managing chronic physical conditions. The problem is that mental health care and physical health care commonly don’t live in the same place, and patients are expected to move between those systems on their own, which is hard under any circumstances.

From a pharmacy standpoint, we often end up seeing the whole picture. We’re looking at psychiatric medications alongside everything else they’re prescribed, and we’re sometimes the first ones to notice when something isn’t lining up. Pharmacists are often the ones communicating with different providers who may not be regularly communicating with each other. It’s not a perfect solution, but in a very disjointed system pharmacists can help connect pieces that would otherwise stay separate. In my opinion, if pharmacists could get reimbursement for comprehensive medication management and be granted provider status, then we could be more effective at bridging this gap.

Pharmacy Times: There is a well-documented shortage of psychiatric providers in the U.S. How can pharmacists help alleviate workforce strain while maintaining high-quality, patient-centered care?

McGuire: According to Tom Insel in his book Healing: Our Path from Mental Illness to Mental Health, the shortage issue with psychiatric providers is actually a distribution problem. There are large swaths of this country with large numbers of patients per one mental health provider and other sections with incredibly small ratios. Pharmacists can help relieve some of that strain by taking on some of the work that doesn’t require a psychiatrist but still matters a lot. We’re administering long-acting injectables, tracking when patients actually received their last dose, catching medication errors, and noticing when something doesn’t add up. I’ve had psychiatrists tell me that some of the most helpful information they get is from a pharmacist saying, “Your patient was here, and I noticed some signs you may want to check in with them about.”

That kind of involvement helps stretch a limited workforce without lowering the quality of care. As a trained group of medical professionals already seeing these patients regularly, we can take pressure off the system and help prevent problems before they escalate.

Pharmacy Times: Medication adherence remains a major challenge in psychiatric care. What role can pharmacists play in identifying early warning signs of nonadherence before they escalate to hospitalization or crisis care?

McGuire: A lot of nonadherence shows up long before a patient ends up in the hospital, but someone has to be paying attention. Pharmacists are often in a position to see those early signs because patients still come to the pharmacy, even if they’re disengaging from other parts of care.

It might be missed refills or a patient showing up who just seems off, such as if they're talking faster, acting distractedly, or saying they haven’t been sleeping. While these signs don't cause alarm for an immediate emergency, they’re signals that a check-in with their provider may be warranted. I’ve seen situations where a pharmacist noticing that and making a phone call to the provider helped trigger an earlier intervention. Recognizing when something is changing and communicating that before it turns into a crisis or a hospitalization is paramount.

Pharmacy Times: On National Pharmacist Day, what do you think is most important for health systems and policymakers to understand about the value pharmacists bring to psychiatric and serious mental illness care?

McGuire: I think what’s most important to understand is that pharmacists are already doing this work; we’re just not always fully recognized or empowered within care and reimbursement systems. We’re seeing patients regularly, administering medications, catching errors, and flagging concerns when someone needs support.

Pharmacists can help fill gaps in care, especially around continuity and access, and have the capability to help meet a need for individuals who so often can’t advocate for themselves. But without things like provider status and better integration into care teams, our ability to help is limited. On days like National Pharmacist Day, I’d like policymakers and health systems to see pharmacists not as an add-on, but as a practical, ready workforce that can help keep patients living with SMI out of crisis if we’re empowered to work at the top of our training.